Hosoda K, Fujita S, Kawaguchi T, Shibata Y, Tamaki N
Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji, Japan.
Surg Neurol. 1999 Aug;52(2):153-5. doi: 10.1016/s0090-3019(99)00039-7.
Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion.
A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm.
Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA.
This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.
颅外颈内动脉动脉瘤（EICAA）是罕见的病变。切除并移植是首选的治疗方法。然而，关于此类动脉瘤手术中分流使用的细节，鲜有文章进行描述。我们描述一种经动脉瘤内跨孔插入的外-内分流术。
一名55岁女性，有一个逐渐增大的搏动性颈部肿块，病史5年。检查未发现神经功能缺损。右侧颈动脉血管造影显示一个囊状EICAA，累及颈内动脉（ICA）分叉远端，颈内动脉有扭曲。EICAA的瘤顶从C4上缘延伸至C2中部，最大直径为4 cm。
采用分流技术，我们成功切除了动脉瘤并重建了ICA。端端吻合很容易，因为分流仅涉及ICA的远端游离端，而不涉及ICA的近端游离端。
当需要分流以维持脑循环时，该技术可作为治疗EICCA的一种选择。
